Robot-assisted Heller myotomy for achalasia. Technique and results

: Since its first description in 1991, laparoscopic Heller myotomy has been associated with better short-term outcomes and shorter recovery time, compared to open operation and it is now generally accepted as the procedure of choice for achalasia. Despite the well-known short-term benefits of laparoscopy, esophageal perforation still occurs. Robotic technology has recently been introduced into laparoscopic clinical practice with the aim of improving surgical performance and excellent results have been described with robotically assisted Heller myotomy in patients with achalasia. The 3-D visualization, the very steady operative view and, above all, the articulated arms of the da Vinci Robotic Surgical System allow the surgeon to visualize and divide each individual muscular fiber, easily identifying the submucosal plane at the GE junction. However, no high-quality studies are available in literature. Moreover, from an economic point of view, the use of the robotic technology may increase both the costs and the volume of surgeries performed.